| NPI | 1376965020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38603) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021521) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2023-02-07 |