| NPI | 1215466875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041635) |
| 225100000X Physical Therapist (Licence: NC P19969) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2024-01-16 |