| NPI | 1184104606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X (Licence: FL POR160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT17641) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2025-06-26 |