| NPI | 1609262138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1217440) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015759) |
| 225100000X Physical Therapist (Licence: NY 033650) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-04-10 |