| NPI | 1679982763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23771) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29527) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2025-02-11 |