| NPI | 1508593609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21502) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11760) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2025-07-02 |