| NPI | 1881998532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12977) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2022-01-13 |