| NPI | 1235908427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 40994) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2025-04-17 |