| NPI | 1588903017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 13421) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT13421) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2013-02-04 |