| NPI | 1558603191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12166) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2022-06-16 |