| NPI | 1457707028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1246401) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2025-10-02 |