| NPI | 1033623285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 5202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13438) |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2021-06-19 |