| NPI | 1932647963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215575) |
| Additional Taxonomies | 226300000X Kinesiotherapist |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2023-05-31 |