| NPI | 1356009922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0018806) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2025-01-06 |