| NPI | 1053744904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41143) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24628) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2024-06-25 |