| NPI | 1902359359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33282) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012661A) |
| 225100000X Physical Therapist (Licence: TX 1281099) | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2022-01-25 |