| NPI | 1093223893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14064-24) |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2023-03-20 |