| NPI | 1336484245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9622) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1214529) |
| 225100000X Physical Therapist (Licence: CO 11656) | |
| 225100000X Physical Therapist (Licence: FL 27304) | |
| 225100000X Physical Therapist (Licence: MA 20290) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2014-08-21 |