| NPI | 1427599042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018017825) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32327) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2021-12-21 |