| NPI | 1447431051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 2466) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2582) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2020-05-06 |