| NPI | 1588076970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016594) |
| 225100000X Physical Therapist (Licence: FL PT27854) | |
| 225100000X Physical Therapist (Licence: MA 157902) | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |