| NPI | 1720277452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 14744) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2019-09-18 |