| NPI | 1841259439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34074) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01960) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-08-03 |