| NPI | 1609423243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP031944T) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-08-20 |