| NPI | 1265069793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1359668) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2023-03-15 |