| NPI | 1407707995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24670) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP053275T) |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-02-24 |