| NPI | 1093237349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 026074) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT026074) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2024-10-15 |