| NPI | 1457593378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34567) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019817) |
| 225100000X Physical Therapist (Licence: IL 070017336) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2022-10-27 |