| NPI | 1073824298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 25571) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13212) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2016-05-12 |