| NPI | 1295888410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 3422) |
| Additional Taxonomies | 251B00000X Case Management |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2019-08-08 |