| NPI | 1902671803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP026148T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP024533T) |
| 225100000X Physical Therapist (Licence: VA 2305215986) | |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2023-11-20 |