| NPI | 1487876512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT-009765-L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 2484) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |