| NPI | 1265673644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25425) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019791) |
| 225100000X Physical Therapist (Licence: NY 031079-1) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2012-09-21 |