| NPI | 1417272220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30915) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070017043) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2018-11-07 |