| NPI | 1932930757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 15139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 27792) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2025-10-07 |