| NPI | 1366832271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 4190) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3002) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2016-07-19 |