| NPI | 1093231656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32651) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2025-07-16 |