| NPI | 1588629349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6828) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-08-13 |