| NPI | 1720329428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-4285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 1423) |
| 225100000X Physical Therapist (Licence: UT 8222367-2401) | |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2015-10-08 |