| NPI | 1750266078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24255) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| Enumeration Date | 2025-08-06 |
| Last Update Date | 2025-08-11 |