| NPI | 1073894655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207091) |
| 225100000X Physical Therapist (Licence: MA 19080) | |
| 225100000X Physical Therapist (Licence: TX 1198851) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-08 |