| NPI | 1154014777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41494) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 2421) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2025-07-03 |