| NPI | 1780971259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 26569) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2015-07-14 |