| NPI | 1205668712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42055) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0020692) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2025-06-25 |