| NPI | 1861144735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40866) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1340328) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2023-09-12 |