| NPI | 1275991424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32445) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003441) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2017-04-21 |