| NPI | 1750848214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-27322) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212609) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2025-04-09 |