| NPI | 1992934848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 23664) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009441A) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |