| NPI | 1588222129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 4103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34634) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-05-22 |