| NPI | 1437801974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-01-31 |