| NPI | 1629816699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTT41825) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41825) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2025-06-03 |