| NPI | 1255785507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28609) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 3960) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |