| NPI | 1588858179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 06867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008375A) |
| 225100000X Physical Therapist (Licence: IL 070019472) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2016-04-06 |