| NPI | 1871394114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016550) |
| Enumeration Date | 2025-03-22 |
| Last Update Date | 2025-08-26 |