| NPI | 1629378666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213248) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 8223) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2023-04-20 |