| NPI | 1942701438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 4475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 4475) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2020-04-28 |