| NPI | 1801461785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20638) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT20638) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2023-07-03 |