| NPI | 1538349386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC PT9299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27038) |
| 225100000X Physical Therapist (Licence: NV 1360) | |
| 225100000X Physical Therapist (Licence: RI PT01475) | |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2012-07-23 |