| NPI | 1982217949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9488) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT31226) |
| 225100000X Physical Therapist (Licence: FL PT35827) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-29 |