| NPI | 1528688413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19885) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD PT19855) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |