| NPI | 1861377236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA CP054492T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT021960) |
| Enumeration Date | 2025-08-06 |
| Last Update Date | 2026-05-08 |