| NPI | 1487082632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29418) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022971) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2014-10-16 |