| NPI | 1306046560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24832) |
| Additional Taxonomies | 171W00000X Contractor (Licence: IN 05008930A) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2023-08-03 |