| NPI | 1902131931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 1662-19) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 2073243) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PTA 21970) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: IA 00945) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: WI 1662-19) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2015-08-17 |