| NPI | 1568600807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 17752) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD 17752) |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2019-11-15 |