| NPI | 1275335549 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034263) | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ IP-25-02) | 
| 225100000X Physical Therapist (Licence: AZ IP-25-02) | |
| Enumeration Date | 2025-03-26 | 
| Last Update Date | 2025-08-27 |