| NPI | 1962133025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT6132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213580) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2022-06-20 |