| NPI | 1871718072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026914) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |