| NPI | 1700543980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9341) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2021-12-09 |