| NPI | 1407365877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32821) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL PT32821) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2018-04-17 |