| NPI | 1164895603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208362) |
| 225100000X Physical Therapist (Licence: DC PT871974) | |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2016-06-21 |