| NPI | 1013105170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01317300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008901A) |
| 225100000X Physical Therapist (Licence: MI 5501012700) | |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2012-06-28 |