| NPI | 1275637647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20045) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10550) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-09 |