| NPI | 1376190017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028024) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2026-01-14 |