| NPI | 1437148913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19191) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 016620) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2024-02-12 |