| NPI | 1154694040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3164) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04369) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2018-04-17 |