| NPI | 1174807770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030698) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070017334) |
| 225100000X Physical Therapist (Licence: TX 1196329) | |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2011-10-01 |