| NPI | 1578927992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 28372) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 17913) |
| 225100000X Physical Therapist (Licence: PA PT009419L) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2018-12-14 |