| NPI | 1871955872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036405) |
| 225100000X Physical Therapist (Licence: TX 1269063) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2016-03-28 |