| NPI | 1851651293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40211) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1229050) |
| 225100000X Physical Therapist (Licence: NY 027788) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2014-06-09 |