| NPI | 1669744785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 22943) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22943) |
| Enumeration Date | 2012-02-05 |
| Last Update Date | 2020-09-28 |