| NPI | 1255637013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209356) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23419) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2015-06-12 |