| NPI | 1558734079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39809) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26303) |
| 225100000X Physical Therapist (Licence: FL PTT39809) | |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2023-05-04 |