| NPI | 1912681289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0020532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 39633) |
| 225100000X Physical Therapist (Licence: MA PTL227519) | |
| 225100000X Physical Therapist (Licence: TN 16239) | |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-05-21 |