| NPI | 1750678025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26420) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 26420) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2020-10-12 |