| NPI | 1427422419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 170254) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2015-11-14 |
| Last Update Date | 2015-11-14 |