| NPI | 1881029676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 8926) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2015-02-03 |