| NPI | 1407223506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1302300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012769A) |
| 225100000X Physical Therapist (Licence: IL 070023568) | |
| 225100000X Physical Therapist (Licence: NY 042654) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2018-08-10 |