| NPI | 1871701110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2005012166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020108) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-07-10 |