| NPI | 1427385640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT2802) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 19227) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2009-11-09 |