| NPI | 1598789802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 20791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007858) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-02-22 |