| NPI | 1942975651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20827) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029705) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2022-02-11 |