| NPI | 1982786505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 24634) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4924) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-07-21 |