| NPI | 1649288317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 005803) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3372) |
| 225100000X Physical Therapist (Licence: NC 9924) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2019-05-03 |