| NPI | 1255151197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42516) |
| Enumeration Date | 2024-10-15 |
| Last Update Date | 2024-12-23 |