| NPI | 1447450960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14683) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2021-03-22 |