| NPI | 1063173227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-6042) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: HI PTA-611) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2024-11-29 |