| NPI | 1285162180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211046) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2023-04-13 |