| NPI | 1730811720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP013252T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215172) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-07-04 |