| NPI | 1982220315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15133-24) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 11807) |
| 225100000X Physical Therapist (Licence: MN 11807) | |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2021-03-02 |