| NPI | 1336629146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 18167) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-10-10 |