| NPI | 1427316595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT3123) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: FL PT3123) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: FL PT3123) | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2015-03-13 |