| NPI | 1649450388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2187) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2021-08-06 |