| NPI | 1538813712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38318) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2023-10-17 |