| NPI | 1447860390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 42282) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19696) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-11-06 |