| NPI | 1558851352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH CP046680T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62702) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2025-07-30 |