| NPI | 1225177611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029091) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2022-11-14 |