| NPI | 1174183354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37197) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004139) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-03-23 |