| NPI | 1790277473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 089421) |
| 225100000X Physical Therapist (Licence: TX 1295006) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-07-23 |