| NPI | 1457157307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303744) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IN 0515950A) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-09-06 |