| NPI | 1659003366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217387) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: FL PT38379) | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2025-09-30 |