| NPI | 1801666466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30171) |
| 225100000X Physical Therapist (Licence: NY 050542) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2025-01-27 |