| NPI | 1396119541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 2521) |
| 225100000X Physical Therapist (Licence: CA 33183) | |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |