| NPI | 1114791092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216170) |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2023-11-10 |