| NPI | 1699426734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14962) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P20569) |
| 225100000X Physical Therapist (Licence: NY 048006) | |
| 225100000X Physical Therapist (Licence: VA CP010420T) | |
| 225100000X Physical Therapist (Licence: IA 112350) | |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2023-03-28 |