| NPI | 1184784571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6164) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 11095) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2024-04-03 |