| NPI | 1083507313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL88631) |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2026-01-26 |