| NPI | 1588606073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT364443) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2818) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2024-12-03 |