| NPI | 1326389487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0012469) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006205) |
| 225100000X Physical Therapist (Licence: VA 2305207879) | |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2014-01-10 |