| NPI | 1093600769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 20896) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 20896) |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-06-11 |