| NPI | 1528591799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 29103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14806) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2017-04-05 |