| NPI | 1033491428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13297) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2021-10-06 |