| NPI | 1154337293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28046) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 001444) |
| 225100000X Physical Therapist (Licence: PA PT020396) | |
| 225100000X Physical Therapist (Licence: OH PT 012836) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2016-05-27 |