| NPI | 1114602455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42826) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 33033) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2025-05-06 |