| NPI | 1164625414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 1660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT004350) |
| 225100000X Physical Therapist (Licence: FL PT6909) | |
| 225100000X Physical Therapist (Licence: NY 0021101) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |