| NPI | 1538693577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 3070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 1816) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |