| NPI | 1699204800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26510) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2024-01-12 |