| NPI | 1053540641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8375) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031431-1) |
| 225100000X Physical Therapist (Licence: FL 26290) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2017-04-25 |