| NPI | 1538173877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 28116) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010095) |
| 225100000X Physical Therapist (Licence: CO 9906) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2015-06-24 |