| NPI | 1851893010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291286) |
| 225100000X Physical Therapist (Licence: NY 034033) | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |