| NPI | 1265498216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 1604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 02755) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-09-21 |