| NPI | 1679347538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 303533) |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2023-11-10 |