| NPI | 1477101061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18935) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT.9715) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2025-07-08 |