| NPI | 1285780007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 870533) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2011-01-14 |