| NPI | 1356585483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0015879) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030617-1) |
| 225100000X Physical Therapist (Licence: FL PT27724) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2021-03-22 |