| NPI | 1447333760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT6204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9100633) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-05-05 |