| NPI | 1386721132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12052) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT21679) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-04-08 |