| NPI | 1295202331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 39356) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11737) |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2023-01-04 |