| NPI | 1255592291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 26146) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019301) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2024-01-25 |