| NPI | 1871694471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AR PT 2286) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: AR 2286) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-08-15 |