| NPI | 1437311271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0055310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2335) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2021-05-17 |