| NPI | 1366452872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 000581) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-05-26 |