| NPI | 1871972034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP053881T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209444) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2026-03-10 |