| NPI | 1720098080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT21425) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P7677) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2024-02-29 |