| NPI | 1396141925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21783) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT29658) |
| 225100000X Physical Therapist (Licence: OR 61046) | |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2024-08-21 |