| NPI | 1578817797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208021) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9198) |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2013-09-04 |