| NPI | 1922735372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT7247) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015926) |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2025-11-18 |