| NPI | 1194910976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT2188) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA6520) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2021-02-15 |