| NPI | 1194145243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT5119) |
| 225100000X Physical Therapist (Licence: TX 1238968) | |
| 225100000X Physical Therapist (Licence: NC P14802) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |