| NPI | 1700566007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 40393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 19183) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |