| NPI | 1215821046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43185) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30374) |
| Enumeration Date | 2025-06-05 |
| Last Update Date | 2025-06-05 |