| NPI | 1417503541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21661) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT35005) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2022-09-20 |