| NPI | 1407377658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC PT9384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32565) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2024-04-22 |