| NPI | 1518937283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 4786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 004786) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-08-24 |