| NPI | 1497159917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 14730) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11593) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2022-10-25 |