| NPI | 1982203840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11746R) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2024-07-01 |