| NPI | 1073651535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 2966) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1102069) |
| 225100000X Physical Therapist (Licence: NJ 40QA00798400) | |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2007-07-08 |