| NPI | 1740521350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7057) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 7057) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2018-03-17 |