| NPI | 1477956233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25305) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2015-10-17 |