| NPI | 1679336333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41098) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2025-11-14 |