| NPI | 1245433838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 28043) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6497) |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2013-05-30 |