| NPI | 1003292640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT200001383) |
| 225100000X Physical Therapist (Licence: NY 050291) | |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2025-09-16 |