| NPI | 1780767913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 9995) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 9995) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-02-02 |