| NPI | 1508246588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT 3992) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2022-10-28 |