| NPI | 1922538230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37382) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007101) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-09-27 |