| NPI | 1861701252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020906) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10694) |
| 225100000X Physical Therapist (Licence: NY 032629) | |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2016-06-24 |