| NPI | 1790341782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 34383) |
| 225100000X Physical Therapist (Licence: CO 017915) | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2021-12-18 |