| NPI | 1487244828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 36677) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026339) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |