| NPI | 1538610902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11708) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2019-05-17 |