| NPI | 1861424202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 9800-024) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: IL 070-013596) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-08-19 |