| NPI | 1063726016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 20888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 005214) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2010-08-02 |