| NPI | 1558944611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP061234T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501019991) |
| 225100000X Physical Therapist (Licence: DC PT210002494) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2026-08-27 |