| NPI | 1992565188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26614) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216221) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2024-03-22 |