| NPI | 1265040042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1331582) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2025-08-21 |