| NPI | 1467881482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13057) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2022-11-29 |