| NPI | 1871473280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 309570) |
| 225100000X Physical Therapist (Licence: FL PT43742) | |
| Enumeration Date | 2025-09-05 |
| Last Update Date | 2026-08-03 |