| NPI | 1225684095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30232) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2025-01-02 |