| NPI | 1861903007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34187) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TN 11617) | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2025-08-01 |