| NPI | 1861728867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8857) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2009-10-26 |