| NPI | 1023496015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT4405) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036734) |
| 225100000X Physical Therapist (Licence: OR 61091) | |
| 225100000X Physical Therapist (Licence: FL PT31869) | |
| 225100000X Physical Therapist (Licence: TX 1241843) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2018-05-22 |