| NPI | 1922861558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40661) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1390822) |
| 225100000X Physical Therapist (Licence: CA 307408) | |
| 225100000X Physical Therapist (Licence: SC 12055) | |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2026-02-03 |