| NPI | 1801267406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 30312) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011855) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |