| NPI | 1902941859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTPPTLIC19493) |
| 225100000X Physical Therapist (Licence: IL 070005926) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2025-10-16 |