| NPI | 1326689563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP035542T) |
| 225100000X Physical Therapist (Licence: NC P18855) | |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2024-10-21 |