| NPI | 1144827940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38544) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61106591) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2024-01-16 |