| NPI | 1568760130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038772-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT013169) |
| 225100000X Physical Therapist (Licence: PA PT021206) | |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2015-06-23 |