| NPI | 1811072473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT0014520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL20882) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-03-25 |