| NPI | 1013127190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 4942) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-01-23 |