| NPI | 1568117497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4778) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CA 301622) | |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-03-01 |