| NPI | 1760865885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038939) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14119) |
| 225100000X Physical Therapist (Licence: SC 6964) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |