| NPI | 1720960610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42163) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P23797) |
| 225100000X Physical Therapist (Licence: CA 306900) | |
| 225100000X Physical Therapist (Licence: GA PT017814) | |
| Enumeration Date | 2025-07-22 |
| Last Update Date | 2025-07-22 |