| NPI | 1689826554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029708) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2021-07-22 |