| NPI | 1861852378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25229) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |