| NPI | 1306538863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4528) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 101422) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2023-10-12 |