| NPI | 1093209421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09913) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30254) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2020-08-23 |