| NPI | 1982364386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10710) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1087) |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2024-07-25 |