| NPI | 1821329269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33312) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 0003081) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2021-06-24 |