| NPI | 1336350867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 5611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT43899) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2025-10-17 |