| NPI | 1598272288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 9838) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2022-08-03 |