| NPI | 1376564740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 8060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT0019085) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2011-10-20 |