| NPI | 1245010016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44193) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT031435) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2026-01-17 |