| NPI | 1811829195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 17747) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 17747-24) |
| Enumeration Date | 2026-06-01 |
| Last Update Date | 2026-07-14 |