| NPI | 1598315426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41597) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028022) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2026-06-30 |