| NPI | 1740063114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-33182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24578) |
| 225100000X Physical Therapist (Licence: NC CP049611T) | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2026-08-12 |