| NPI | 1659707966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14310) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2019-03-24 |