| NPI | 1962112359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30632) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39615) |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2025-10-10 |