| NPI | 1497878052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35651) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2025-12-12 |