| NPI | 1669589578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20842) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PT20842) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-12-18 |