| NPI | 1972736726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3069) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8632) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2012-04-23 |