| NPI | 1750554655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT21568) |
| 225100000X Physical Therapist (Licence: GA PT009074) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2024-02-15 |