| NPI | 1821448200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC p16326) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3578) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2021-07-27 |