| NPI | 1164524625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 0252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 252) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2021-10-24 |