| NPI | 1346764412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40145) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE011394) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-05-10 |