| NPI | 1275642845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34797) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008957) |
| 225100000X Physical Therapist (Licence: SC 3835) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-09-20 |