| NPI | 1477646768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305004493) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-06-16 |