| NPI | 1952633166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204052) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019715) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2010-02-12 |