| NPI | 1538657366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 1769) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: HI 1769) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2018-08-29 |