| NPI | 1235835604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 40QA02151200) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-02-06 |