| NPI | 1306367099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297848) |
| 225100000X Physical Therapist (Licence: FL PT32692) | |
| 225100000X Physical Therapist (Licence: PA PT026609) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2020-01-24 |