| NPI | 1124114657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2735) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 104693) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: KS 11-02196) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-11-08 |