| NPI | 1316433352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0134475) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2022-10-28 |