| NPI | 1588912497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27513) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2020-11-24 |