| NPI | 1376269860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32645) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38056) |
| 225100000X Physical Therapist (Licence: LA 11155R) | |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2026-03-10 |