| NPI | 1083662175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22738) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016943) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-07-21 |