| NPI | 1407148521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1201269) |
| Enumeration Date | 2011-05-08 |
| Last Update Date | 2011-07-07 |