| NPI | 1003025156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 16439) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT20119) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-09-11 |