| NPI | 1114647112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 18617) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2024-10-25 |