| NPI | 1376436345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP044658T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH12307) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-06-02 |