| NPI | 1255707287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1245982) |
| 225100000X Physical Therapist (Licence: FL PT31976) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2018-04-27 |