| NPI | 1336235217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38368) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 38368) |
| 225100000X Physical Therapist (Licence: OK PT2458) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-04-01 |