| NPI | 1548488554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022349-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204774) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |