| NPI | 1629784871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19726) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213880) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2024-05-23 |