| NPI | 1619917127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60142849) |
| 225100000X Physical Therapist (Licence: NY 017397) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 017397) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2014-05-16 |