| NPI | 1215321294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12921-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29653) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-05-29 |