| NPI | 1801291869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7545) |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2014-11-01 |