| NPI | 1184352650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39206) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT39206) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-08-11 |