| NPI | 1669218541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 223416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 4347) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-01 |