| NPI | 1114278512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 9188) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: 9188) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2023-06-28 |