| NPI | 1639590805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15196) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27489) |
| 225100000X Physical Therapist (Licence: SC CP036776T) | |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2025-08-12 |