| NPI | 1205919644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT870480) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23820) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2014-12-31 |