| NPI | 1083098503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R56456) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2024-12-26 |