| NPI | 1215105630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34485) |
| 225100000X Physical Therapist (Licence: NV 2594) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2017-03-25 |