| NPI | 1861597825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10763) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-11-16 |