| NPI | 1568180230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL pt39002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1352907) |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |