| NPI | 1386817542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009292) |
| 225100000X Physical Therapist (Licence: NY 019287) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2012-05-11 |