| NPI | 1679905459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38495) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208123) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2022-07-26 |