| NPI | 1184060899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT21524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 21524) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2022-06-09 |