| NPI | 1639364821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22720) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT13223) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2024-12-18 |