| NPI | 1851799845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40420) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2740) |
| 225100000X Physical Therapist (Licence: NC 13889) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2014-12-08 |