| NPI | 1376796045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT010571L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 12869) |
| 225100000X Physical Therapist (Licence: MI 5501006867) | |
| 225100000X Physical Therapist (Licence: NC 6511) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |