| NPI | 1043238710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 400) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-11-05 |