| NPI | 1689935934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2444) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2021-08-08 |