| NPI | 1720282825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34614) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028864) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2014-06-16 |