| NPI | 1871053397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35622) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM PT5431) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2020-03-02 |