| NPI | 1710016142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1180173) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012255) |
| 225100000X Physical Therapist (Licence: FL PT22595) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2018-08-21 |