| NPI | 1912342189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 5022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 4936671-2401) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2020-11-04 |