| NPI | 1063958239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012741) |
| 225100000X Physical Therapist (Licence: TN 11640) | |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2024-02-08 |