| NPI | 1720252802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5951) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC p2696) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2025-06-02 |