| NPI | 1417183476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11251) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11251-24) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2022-07-21 |