| NPI | 1083135362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210097) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2020-03-25 |