| NPI | 1124749379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTT39366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216676) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2024-08-21 |