| NPI | 1902108442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P10859) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60152) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2021-12-21 |