| NPI | 1255749701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 134958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211951) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2023-11-13 |