| NPI | 1417078486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 18536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 3981) |
| 225100000X Physical Therapist (Licence: NJ 40QA01206700) | |
| 225100000X Physical Therapist (Licence: KS 11-03670) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-09 |