| NPI | 1831419407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH 4865) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT23536) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2010-06-07 |