| NPI | 1366249013 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002582) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 052968) | 
| 225100000X Physical Therapist (Licence: FL PT42906) | |
| Enumeration Date | 2025-02-28 | 
| Last Update Date | 2025-09-02 |