| NPI | 1144612227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: AZ 10700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 035087) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2024-01-25 |