| NPI | 1285378174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217370) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26141) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2025-10-29 |