| NPI | 1891911418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 119452-2401) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2014-12-10 |