| NPI | 1447081799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0020663) |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2026-03-04 |