| NPI | 1083168660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10976) |
| 225100000X Physical Therapist (Licence: SC 10647) | |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2022-09-22 |