| NPI | 1083001234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-3844) |
| 225100000X Physical Therapist (Licence: DE J1-0003931) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2019-11-26 |