| NPI | 1184262685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33190) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT17887) |
| Enumeration Date | 2019-12-15 |
| Last Update Date | 2019-12-15 |