| NPI | 1528490695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25696) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PTS25696) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2022-05-03 |