| NPI | 1629037775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS009326L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT006256L) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2014-03-05 |