| NPI | 1376274449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048775) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019467) |
| 225100000X Physical Therapist (Licence: FL PT39477) | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2026-05-17 |