| NPI | 1679905095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28504) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: FL PT28504) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PT28504) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2013-08-09 |