| NPI | 1134631104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30363) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23328) |
| 225100000X Physical Therapist (Licence: NY 041797) | |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2024-06-20 |