| NPI | 1871173229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 090368) |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2021-04-10 |