| NPI | 1174152375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 33916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 30291) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2024-06-28 |