| NPI | 1295843191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018358-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT17656) |
| 2251H1200X Physical Therapist, Hand (Licence: NY 018358-1) | |
| 2251H1200X Physical Therapist, Hand (Licence: FL PT17656) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2013-09-17 |