| NPI | 1558740720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30517) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209392) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2020-12-02 |