| NPI | 1912424748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35792) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11592) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2023-07-18 |