| NPI | 1275123986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT.10545) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2022-03-01 |