| NPI | 1457852980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35661) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013312) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2025-04-16 |