| NPI | 1861598468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 1244) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 104178) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-08 |