| NPI | 1730701368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35713) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297861) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-07-29 |