| NPI | 1447370770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0284111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60232504) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2018-04-19 |