| NPI | 1104593359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44192) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP049062T) |
| 225100000X Physical Therapist (Licence: MS PT7224) | |
| 225100000X Physical Therapist (Licence: CA 303524) | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2026-01-05 |