| NPI | 1962891960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT870993) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23262) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |