| NPI | 1558694596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 16949) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: FL 16949) |
| 2251S0007X Physical Therapist, Sports (Licence: FL 16949) | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2009-09-09 |