| NPI | 1366564403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT21162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8800) |
| 225100000X Physical Therapist (Licence: WA PT00009840) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |