| NPI | 1447461652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT-23233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028677) |
| 225100000X Physical Therapist (Licence: DE J1-0002162) | |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2007-07-08 |