| NPI | 1235611385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31938) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 31938) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2023-10-09 |