| NPI | 1275993123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6116) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 2253) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-03-03 |