| NPI | 1538345566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20587) |
| Additional Taxonomies | 171W00000X Contractor (Licence: FL PT20587) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2018-10-03 |