| NPI | 1184638728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT19168) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT19168) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-05-22 |