| NPI | 1154757243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2930) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 5226) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2021-10-26 |