| NPI | 1811687478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL ME41236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1375925) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-07-24 |