| NPI | 1164831483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 30848) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208888) |
| 225100000X Physical Therapist (Licence: VI 199) | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2021-07-30 |