| NPI | 1780398735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 41655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 32733) |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2024-10-31 |