| NPI | 1609558246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22492) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2025-04-22 |