| NPI | 1902975329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PR 1212) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 1212) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2021-11-03 |