| NPI | 1831212745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: IN 05005892A) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-08-29 |