| NPI | 1760488258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 13398) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT003663) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2022-07-21 |