| NPI | 1508834292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2088) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5013) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-09-27 |