| NPI | 1548503071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41034) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034087) |
| 225100000X Physical Therapist (Licence: HI PT-4164) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2016-03-11 |