| NPI | 1922202852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 17173) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8811) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2007-07-08 |