| NPI | 1871275289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40246) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215988) |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2025-01-23 |