| NPI | 1821560467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022013468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14512-24) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2024-10-09 |