| NPI | 1235731001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 70025190) |
| 225100000X Physical Therapist (Licence: NC P23388) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2025-06-12 |