| NPI | 1316191828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008193L) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2025-07-11 |