| NPI | 1609608199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 307922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6939) |
| 225100000X Physical Therapist (Licence: AZ CP038596T) | |
| 225100000X Physical Therapist (Licence: OH PT021365) | |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2026-04-22 |