| NPI | 1942406228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8503) |
| 225100000X Physical Therapist (Licence: MS 5677) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2018-03-17 |