| NPI | 1265886998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 009681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14627) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2016-04-19 |