| NPI | 1518440478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40762) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27003) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2023-09-13 |