| NPI | 1730226747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2398) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT16888) |
| 225100000X Physical Therapist (Licence: FL PT 16888) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-05-12 |