| NPI | 1255068326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT32493) |
| 225100000X Physical Therapist (Licence: FL PT41269) | |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2026-05-07 |