| NPI | 1215251335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PTO12522L) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2019-03-06 |