| NPI | 1225539943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT5482) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL0015260) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2018-02-27 |