| NPI | 1497005284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1242132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01457600) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2016-06-22 |