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