| NPI | 1700328465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 39847) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26750) |
| Enumeration Date | 2016-11-12 |
| Last Update Date | 2023-11-15 |