| NPI | 1881936565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7994) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 24343) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2016-01-26 |