| NPI | 1518511062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13082) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34939) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2025-09-08 |