| NPI | 1114574670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03215) |
| 225100000X Physical Therapist (Licence: SC 10960) | |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2025-03-13 |