| NPI | 1902466204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36934) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH1418) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2021-03-12 |