| NPI | 1871978239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38374) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL pta21481) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2022-03-15 |