| NPI | 1881723724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2005029646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 7417) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |