| NPI | 1316558232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30637) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2021-03-27 |