| NPI | 1750185583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03971) |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2026-01-22 |