| NPI | 1053505586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26491) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5571) |
| 225100000X Physical Therapist (Licence: CO 9632) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2025-05-14 |