| NPI | 1194869529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016539) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2013-01-02 |