| NPI | 1255715413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 29847) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2022-09-20 |