| NPI | 1356748669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7414) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL pt29489) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2014-12-02 |