| NPI | 1013600907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31698) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1353113) |
| 225100000X Physical Therapist (Licence: GA PT012576) | |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2023-05-29 |