| NPI | 1790176550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011662A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1214149) |
| 225100000X Physical Therapist (Licence: MI 5501014880) | |
| 225100000X Physical Therapist (Licence: KY 005966) | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2015-02-13 |