| NPI | 1043435266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT23488) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT2700) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2021-06-24 |