| NPI | 1760875900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26535) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7544) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2017-11-15 |