| NPI | 1093163081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13416) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2019-06-26 |