| NPI | 1194722967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 003180) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26204) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2018-10-29 |