| NPI | 1356714810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295470) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012442A) |
| 225100000X Physical Therapist (Licence: KY 006756) | |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2026-08-24 |