| NPI | 1407247810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4858) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2015-02-08 |
| Last Update Date | 2023-07-06 |