| NPI | 1689976052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA pending) |
| 225100000X Physical Therapist (Licence: FL PT 25988) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2025-08-26 |