| NPI | 1699740605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 1962) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2018-12-16 |