| NPI | 1285677435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 5362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT20151) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-09-12 |