| NPI | 1528433737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 011318) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30818) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2026-01-06 |