| NPI | 1588801716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25317) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019572) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2013-09-03 |