| NPI | 1780428466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP058414T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT021215) |
| 225100000X Physical Therapist (Licence: MI 5501304465) | |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2026-06-10 |