| NPI | 1558852673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 14226-24) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2022-05-13 |