| NPI | 1568861870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33466) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208753) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2022-05-26 |