| NPI | 1285046573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12181) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14608) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2025-03-03 |