| NPI | 1033037395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 40932) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 89685) |
| Enumeration Date | 2026-07-06 |
| Last Update Date | 2026-07-12 |