| NPI | 1164490181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64801) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 11326) |
| 225100000X Physical Therapist (Licence: AZ 6480) | |
| 225100000X Physical Therapist (Licence: NV 1924) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-03-07 |