| NPI | 1720436058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 4229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61698) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2019-10-22 |