| NPI | 1356827448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11801) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2022-01-06 |