| NPI | 1699285908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31208) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PT31208) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2021-06-07 |