| NPI | 1336549229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12948-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8887515-2401) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2016-12-07 |