| NPI | 1114133097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22626) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2017-02-24 |