| NPI | 1881484384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30753) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD T18444) |
| Enumeration Date | 2025-05-08 |
| Last Update Date | 2026-02-06 |