| NPI | 1770609638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT4201) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07014) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2025-11-17 |