| NPI | 1023538329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT09065PT) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2019-06-11 |