| NPI | 1700984051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 22333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22333) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-10-27 |