| NPI | 1477161651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27848) |
| 225100000X Physical Therapist (Licence: TX 1326113) | |
| 225100000X Physical Therapist (Licence: CO MSPTL.0000012) | |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2024-10-17 |