| NPI | 1245574599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207746) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14016) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2016-11-30 |