| NPI | 1720436017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21795) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34514) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2023-09-03 |