| NPI | 1679546964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5828) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P2975) |
| 225100000X Physical Therapist (Licence: FL PT29040) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2024-07-17 |