| NPI | 1831472059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029053) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2017-02-22 |