| NPI | 1609642404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 5815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 11062) |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2023-12-05 |