| NPI | 1366152654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 39538) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 15726) |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2025-11-10 |