| NPI | 1164869764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24336) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207721) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2013-05-23 |