| NPI | 1043519127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT3712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1200133) |
| 225100000X Physical Therapist (Licence: CO PTL.0012015) | |
| 225100000X Physical Therapist (Licence: FL PT27321) | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2013-04-10 |