| NPI | 1629116389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9582) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA pt008923l) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-08-13 |