| NPI | 1629557194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1303727) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2022-06-06 |