| NPI | 1467700393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8524936-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT5183) |
| 225100000X Physical Therapist (Licence: AL PTH9079) | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2025-08-11 |