| NPI | 1386821163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20502) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1183802) |
| 225100000X Physical Therapist (Licence: FL PT24575) | |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2021-09-02 |