| NPI | 1790256832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 34147) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2019-02-13 |