| NPI | 1467700393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9079) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT5183) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2024-03-19 |