| NPI | 1982378303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38189) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214633) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2022-02-03 |