| NPI | 1366694788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12288) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 12288-24) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2025-06-10 |