| NPI | 1629808746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 13055) |
| 2251S0007X Physical Therapist, Sports | |
| 225100000X Physical Therapist (Licence: MA PTL28133) | |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2025-11-21 |