| NPI | 1386047041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040913-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT28961) |
| 225100000X Physical Therapist (Licence: TX 1250455) | |
| 225100000X Physical Therapist (Licence: UT 8601983-2401) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2020-01-11 |