| NPI | 1326605536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 33745) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5537) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-05-22 |