| NPI | 1679782874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2006009610) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 003795) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |