| NPI | 1417931205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 034278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P9694) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2025-10-21 |