| NPI | 1508078130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32979) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 15359) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2018-03-17 |