| NPI | 1609243435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP050669T) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CO 0013596) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2025-11-21 |