| NPI | 1912969155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 7481) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305006661) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2008-07-30 |