| NPI | 1154095008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 37455) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 10439338) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-08-04 |