| NPI | 1619527827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213133) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |