| NPI | 1326261306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4761) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 23039) |
| 225100000X Physical Therapist (Licence: MA 17604) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2017-01-25 |