| NPI | 1730526062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9087) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 07905) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2021-02-02 |