| NPI | 1710708847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 36922) |
| Enumeration Date | 2024-10-22 |
| Last Update Date | 2025-06-13 |