| NPI | 1346873791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9796) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2021-03-15 |