| NPI | 1528250628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-011562) |
| 225100000X Physical Therapist (Licence: NY 016943-1) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2007-08-13 |