| NPI | 1932550274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015027073) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61654) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-06-28 |