| NPI | 1114273372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12113-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9895) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2019-01-04 |