| NPI | 1215200415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32878) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA22671) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2022-07-21 |