| NPI | 1477090603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32242) |
| 225100000X Physical Therapist (Licence: NC 16827) | |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-26 |