| NPI | 1134604770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33979) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT33979) |
| Enumeration Date | 2018-09-29 |
| Last Update Date | 2019-02-08 |