| NPI | 1013606334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41669) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07359) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2024-06-05 |