| NPI | 1275044786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25843) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2023-02-10 |