| NPI | 1073614285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027046-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204833) |
| 225100000X Physical Therapist (Licence: WA PT00010625) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2011-04-11 |