| NPI | 1861256208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 41342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 15457) |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2024-02-07 |