| NPI | 1417791542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21679) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2026-07-22 |