| NPI | 1497470413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40079) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MO 2022030868) | |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2023-04-19 |