| NPI | 1477751923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 26867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 013275) |
| 225100000X Physical Therapist (Licence: NH 1891) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2013-07-01 |