| NPI | 1417848250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP053326T) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CO PTL20617) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: SC CP046535T) | |
| 225100000X Physical Therapist (Licence: TX CP049849T) | |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2026-02-26 |