| NPI | 1982035317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 28878) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-4092) |
| 225100000X Physical Therapist (Licence: FL PT28878) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2020-02-05 |