| NPI | 1013965763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10115) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-05-21 |