| NPI | 1588863799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: LA PT03218) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2025-04-03 |