| NPI | 1497723365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4676) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: SC 4676) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2025-03-20 |