| NPI | 1265974471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 010568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1268879) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |