| NPI | 1588387856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047421) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2025-06-28 |