| NPI | 1245056134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44613) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 033915) |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2026-05-11 |