| NPI | 1154739001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3338) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 2073) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-06-09 |