| NPI | 1588809677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014788-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 007772) |
| 225100000X Physical Therapist (Licence: IN 05003843) | |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2008-12-04 |