| NPI | 1205531118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2018020432) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2024-06-03 |