| NPI | 1417499211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005873) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014248) |
| 225100000X Physical Therapist (Licence: FL PT 31192) | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |