| NPI | 1508289570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28757) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE 353510) |
| 225100000X Physical Therapist (Licence: AZ 10608) | |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |