| NPI | 1194428359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CO PTL.0021361) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-32863) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2026-06-12 |