| NPI | 1437937117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050862) |
| 225100000X Physical Therapist (Licence: FL PT41530) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2024-12-17 |