| NPI | 1699082800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35462) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020893) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2026-03-11 |