| NPI | 1720744642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12456) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4713) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2024-08-02 |