| NPI | 1265031835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213568) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305213568) |
| 225200000X Physical Therapy Assistant (Licence: MD A4332) | |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |