| NPI | 1821016577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33481) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 003155) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-02-19 |