| NPI | 1205519857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP024557T) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 05015246A) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2023-10-09 |