| NPI | 1437925336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216214) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22776) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-12-13 |