| NPI | 1538045331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP054016T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24340) |
| 225100000X Physical Therapist (Licence: SC CP051125T) | |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2026-03-11 |