| NPI | 1295519718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP032535T) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2025-05-22 |