| NPI | 1134953540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42258) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT7168) |
| 225100000X Physical Therapist (Licence: VA 2305216895) | |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2025-06-23 |