| NPI | 1316263650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206189) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2015-06-24 |