| NPI | 1528627940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24225) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-08-13 |