| NPI | 1215203492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 26161) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6372) |
| 225100000X Physical Therapist (Licence: VA 2305207338) | |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2012-04-01 |