| NPI | 1356872378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT292218) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2022-12-23 |