| NPI | 1568144137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA CP053691T) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2026-06-05 |