| NPI | 1568640134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT-23787) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2010-05-13 |