| NPI | 1598295206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33346) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT32637) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2018-01-31 |