| NPI | 1033549571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-4454) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 7940210-2401) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2019-02-04 |