| NPI | 1710430228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 112017) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-10-04 |