| NPI | 1013214816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 27105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13029) |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2012-02-09 |