| NPI | 1538728696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP030726T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16245-24) |
| 225100000X Physical Therapist (Licence: NC P21981) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2025-11-18 |