| NPI | 1538496534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7707) |
| 225100000X Physical Therapist (Licence: MA 18622) | |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2019-10-08 |