| NPI | 1053820365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 33998) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT5155) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2022-04-28 |