| NPI | 1326316001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 26233) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2024-12-11 |