| NPI | 1043083736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41020) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-03-24 |