| NPI | 1326445669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 04126) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: LA 04126) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2014-12-02 |