| NPI | 1235308263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22283) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD M620603648470) |
| 225100000X Physical Therapist (Licence: DC PT870782) | |
| Enumeration Date | 2008-02-24 |
| Last Update Date | 2019-02-27 |