| NPI | 1922055342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 22415) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA PT04010) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2015-04-24 |