| NPI | 1346969003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO PTL.0018614) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2023-03-10 |