| NPI | 1932049723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP0548839T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032074) |
| Enumeration Date | 2026-03-31 |
| Last Update Date | 2026-05-15 |