| NPI | 1407384209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26485) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0134584) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2023-05-30 |