| NPI | 1639334279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2398) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6101) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2024-02-13 |