| NPI | 1437300928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1211528) |
| Additional Taxonomies | 171W00000X Contractor (Licence: IN 05009675A) |
| 225100000X Physical Therapist (Licence: NY 019088) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2011-12-20 |