| NPI | 1629179825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: VA 2305207237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008789) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-05-07 |