| NPI | 1538465513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 021077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002913) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2011-02-08 |