| NPI | 1891053633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1458) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NV 1458) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2019-10-21 |