| NPI | 1346669538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8253) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 29004) |
| 225100000X Physical Therapist (Licence: NC 16199) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2016-09-01 |