| NPI | 1306376991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 298232) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007095) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-12-23 |