| NPI | 1619033453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11625) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT1493) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2023-12-13 |