| NPI | 1841341310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT14792) |
| 225100000X Physical Therapist (Licence: DC PT872233) | |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2020-05-26 |