| NPI | 1457811416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 44466) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305217125) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2026-03-16 |