| NPI | 1700244498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039184-1) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2021-02-22 |