| NPI | 1851053169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39735) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10495) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2023-02-15 |