| NPI | 1063088052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37001) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029256) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-08-20 |