| NPI | 1184513269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2025034004) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-08-25 |