| NPI | 1275888406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT27477) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2017-02-17 |