| NPI | 1508422965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31760) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 012464) |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2019-05-11 |