| NPI | 1396034963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207672) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 032810) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2013-05-06 |