| NPI | 1972818896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9782) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020686) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2026-05-21 |