| NPI | 1407127921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1225050) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2019-06-11 |