| NPI | 1013950468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13262) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT19778) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-03-29 |