| NPI | 1659952661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 167350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014269) |
| 225100000X Physical Therapist (Licence: FL PT35868) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |