| NPI | 1407261985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT22054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10554) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2023-02-22 |