| NPI | 1295351252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2338) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-4998) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2024-08-01 |