| NPI | 1689198871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32618) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015096) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2021-01-07 |