| NPI | 1356822456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34622) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 091378) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2023-04-14 |