| NPI | 1841514924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32204) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 003957) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2022-12-09 |