| NPI | 1407008550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35802) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008067A) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2020-12-01 |