| NPI | 1366458325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2005012155) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-014647) |
| 225100000X Physical Therapist (Licence: OH PT 006742) | |
| 225100000X Physical Therapist (Licence: UT 5668088-2401) | |
| 225100000X Physical Therapist (Licence: FL PT 16203) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-11-01 |