| NPI | 1700473931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029141) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2021-10-15 |