| NPI | 1962779108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT2534) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2025-03-12 |