| NPI | 1326068586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29148) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011729) |
| 225100000X Physical Therapist (Licence: IN 05008811A) | |
| 225100000X Physical Therapist (Licence: NY 027205) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-06-18 |