| NPI | 1407999568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT23447) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225100000X Physical Therapist (Licence: NY 021373) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2025-08-21 |