| NPI | 1770997553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 120714-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 18690) |
| 225100000X Physical Therapist (Licence: HI 1358) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |