| NPI | 1891281465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP025608T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10320) |
| 225100000X Physical Therapist (Licence: VA CP027617T) | |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2024-08-21 |