| NPI | 1083861751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25930) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11785) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2023-10-05 |