| NPI | 1285859587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21168) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD M02246) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2018-02-07 |