| NPI | 1801142914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070017602) |
| 225100000X Physical Therapist (Licence: NY 029263) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |