| NPI | 1447379664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 04985) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 04985) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-10-02 |