| NPI | 1275843005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 25838) |
| Additional Taxonomies | 111NR0400X (Licence: FL PT25838) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2020-06-29 |