| NPI | 1790526689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL88825) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216463) |
| 225100000X Physical Therapist (Licence: CA 307486) | |
| 225100000X Physical Therapist (Licence: NC P23239) | |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2025-08-18 |