| NPI | 1780033985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1274526) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-08-10 |