| NPI | 1952349482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 07456) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: LA a3556) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2021-01-28 |