| NPI | 1578699435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 16288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11103) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |