| NPI | 1265483945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27730) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017716) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-08-18 |