| NPI | 1225581945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 174400000X Specialist (Licence: 05003265A) |
| 251E00000X Home Health (Licence: IN 05003265A) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2023-04-27 |