| NPI | 1881045003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27575) |
| 225100000X Physical Therapist (Licence: FL PT 31499) | |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2020-12-18 |