| NPI | 1881119436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT028799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0015060) |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2021-12-02 |