| NPI | 1205212982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38195) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015033719) |
| 225100000X Physical Therapist (Licence: KS T-04336) | |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2021-12-22 |