| NPI | 1912282237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008699) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2011-10-18 |