| NPI | 1205273075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7041) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2024-02-21 |