| NPI | 1184218166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20089) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11202) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2022-07-27 |