| NPI | 1447458468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29609) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018742) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2015-12-09 |