| NPI | 1639563737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42048) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031838) |
| 225100000X Physical Therapist (Licence: HI 3946) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2015-03-26 |