| NPI | 1033355136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018887) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040-0003813) |
| Enumeration Date | 2008-12-21 |
| Last Update Date | 2012-02-21 |