| NPI | 1225109796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 20996) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 870427) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-10-19 |