| NPI | 1639651870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1311413) |
| 225100000X Physical Therapist (Licence: IL 070008229) | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2019-08-15 |