| NPI | 1497045447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-8988) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2538) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2024-01-12 |