| NPI | 1407114440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT3943) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11395R) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2023-08-10 |