| NPI | 1609005107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 38587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT3159) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2022-09-12 |