| NPI | 1154801132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH3158) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000007516) |
| 225100000X Physical Therapist (Licence: FL PT31843) | |
| Enumeration Date | 2018-08-18 |
| Last Update Date | 2020-03-10 |